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NPI Code Detail

MEDICARE: THE PT BLUEPRINT, LLC

MEDICARE: THE PT BLUEPRINT, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251X0800XOrthopedic Physical Therapist
2225100000XPhysical Therapist

General Provider Information

NPI Number : 1407613870
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE PT BLUEPRINT, LLC
Provider Business Mailing Address
First Line : 2816 HOUSTON ST
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29405-8630
Country : US
Telephone Number : 440-225-1425
Fax Number :
Provider Business Practice Location Address
First Line : 2816 HOUSTON ST
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29405-8630
Country : US
Telephone Number : 440-225-1425
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. CODY GORDON GUNSELMAN
Credential : PT, DPT, OCS
Telephone Number : 440-225-1425
Provider Enumeration Date : 03/04/2024
Last Update Date : 11/08/2025

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Directions to “THE PT BLUEPRINT, LLC ” Practice Location

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